Switching Your Medicare Advantage Plan

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Switching Your Medicare Advantage Plan

Under certain circumstances, you can change Medicare Advantage plans mid-year. Otherwise, you’ll have to wait for the open enrollment period for the year ahead.

I haven’t been too happy with my Medicare Advantage plan this year—I started taking a drug with expensive out-of-pocket costs, and some of the doctors I want to see aren’t included in the plan’s network. Is it too late to switch plans?

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Probably. In most cases, you can only switch plans during open enrollment in the fall, which runs from October 15 to December 7, 2015, for coverage to begin on January 1. But there are a few exceptions. For instance, you can switch into a Medicare Advantage plan with a five-star quality rating anytime during the year—if you have access to one. Only 11 Medicare Advantage plans with prescription-drug coverage earned five-star ratings for 2015. These plans are in certain counties in California, Colorado, Florida, Hawaii, Iowa, Maine, Maryland, New Hampshire, Ohio, Oregon, Virginia, Washington and Wisconsin, and in Washington, D.C. Five-star Medicare Advantage plans without prescription-drug coverage are in certain counties in Illinois, Iowa and Wisconsin. Use the Medicare Plan Finder tool to see if there are any five-star plans in your zip code. See this fact sheet from Medicare Interactive for more information about the star ratings.

You can also switch plans outside of open enrollment if you move to an address that isn’t in your plan’s service area. There are a few other, less likely situations in which you can switch plans throughout the year; for details, see the Special Circumstances fact sheet at Medicare.gov for more information about situations where you can switch plans outside of open enrollment.

If you don’t have a five-star plan in your area or qualify for a special enrollment period, then you’ll need to wait until open enrollment to switch to a new plan. Go to the Medicare Plan Finder around October 15 to find the plans available in your area (Medicare Advantage plans are called Medicare Health Plans in the tool). Type in your drugs and dosages and your general health condition to find your likely out-of-pocket costs for each plan. Also contact the plans and your doctors to see if they are included in the plan’s network.

Got a question? Ask Kim at askkim@kiplinger.com.